Section 5: Medical referrals, appeals and certificates


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  1. I understand that I may be required to attend one of the Department’s Medical Referees for periodic assessments, while claiming Illness Benefit. Is this correct and what is involved?

  2. I received a letter to attend for a Medical Assessment, but due to unforeseen circumstances I cannot attend on the appointed date. What should I do?

  3. Following a Medical Assessment, I was sent a letter stating that I was found fit for work/other types of work and my Illness Benefit payment has now been stopped. I disagree with this decision, what can I do?

  4. I had a Medical Assessment, was found fit for work and I appealed that decision. I have not received any word of (a) what happens now or (b) the result of the appeal. What can I do?

  5. If I am not satisfied with a decision made by the Department in relation to my claim, what can I do?

  6. I have forms/documents to complete for other purposes and one of the questions asks for a claim number for Illness Benefit. What is my Illness Benefit claim number?

  7. I have had a dental/optical procedure carried out and have been told that I should stay out of work for a period of time. The dentist/optician does not have Social Welfare medical certificates. What should I do?

1. I understand that I may be required to attend one of the Department’s Medical Referees for periodic assessments, while claiming Illness Benefit.  Is this correct and what is involved?

 

Yes, while receiving Illness Benefit, your claim will be reviewed from time to time, a review questionnaire will issue to you, and following this you may be asked to attend for a medical assessment. This assessment will be carried out by a Medical Assessor, who is a doctor employed by the Department of Employment Affairs and Social Protection. The Medical Assessor will give an opinion on whether or not you are fit for work.
You will be sent advance notice of your appointment for an assessment. You may bring along whatever medical evidence you wish the doctor to see.
Note:
You must attend for a medical assessment when requested to do so, otherwise your benefit will be suspended.
If the Medical Assessor gives the opinion that you are capable of work (that is your usual work or other categories of work), a Deciding Officer may subsequently decide that you are not entitled to payment of Illness Benefit, and/or to credited contributions. Where payment of Illness Benefit is stopped, you will have a right to appeal the decision.
If you are receiving credited contributions only and these are stopped, you will have a right to seek a review of the decision but not a right to appeal it.

2. I received a letter to attend for a Medical Assessment, but due to unforeseen circumstances I cannot attend on the appointed date. What should I do?

It is very important you attend and submit to this assessment as it is a legal requirement under the Social Welfare code. A change of date will only be made in exceptional circumstances, in which case you should contact the help-desk immediately by telephone on 01-673 2078.

 


3. Following a Medical Assessment, I was sent a letter stating that I was found fit for work/other types of work and my Illness Benefit payment has now been stopped. I disagree with this decision, what can I do? 

If the Medical Assessor gives the opinion that you are capable of work (that is your usual work or other categories of work), a Deciding Officer may subsequently decide that you are not entitled to payment of Illness Benefit, and/or to credited contributions. Where payment of Illness Benefit is stopped, you will have a right to appeal the decision.
To appeal the decision:
Send your appeal directly to the Social Welfare Appeals Office at the address below or by e-mail to swappeals@welfare.ie within 21 days of the date you were notified of the decision.
Social Welfare Appeals Office
D'Olier House
D'Olier Street
Dublin 2
LoCall: 1890 74 74 34 (from the Republic of Ireland only)
For more information, log on to www.welfare.ie
Note: The Social Welfare Appeals Office operates independently of the Department of Employment Affairs and Social Protection.  It is headed by a Chief Appeals Officer and has its own Appeals Officers who make the decisions.

4. I had a Medical Assessment, was found fit for work and I appealed that decision. I have not received any word of (a) what happens now or (b) the result of the appeal. What can I do?

You should contact the Social Welfare Appeals Office at the address or phone number shown below or by e-mail to swappeals@welfare.ie.

Social Welfare Appeals Office
D'Olier House
D'Olier Street
Dublin 2
LoCall: 1890 74 74 34 (from the Republic of Ireland only)

For more information, log on to www.welfare.ie.


5. If I am not satisfied with a decision made by the Department in relation to my claim, what can I do?

If you are not satisfied with a decision, you can have it reviewed. You can also appeal it to the Social Welfare Appeals Office, either straight away or after the review.

To request a review:

  • send any relevant written evidence to the Illness Benefit Section at the following address within 21 days of the date you were notified of the decision.

Illness Benefit Section
Department of Employment Affairs and Social Protection
Áras Mhic Dhiarmada
Store Street
Dublin 1

A Deciding Officer will review your case. If you are not satisfied with the decision after the review, you may appeal it to the Social Welfare Appeals Office, which is independent of the Department of Employment Affairs and Social Protection.

To appeal the decision:

Send your appeal directly to the Social Welfare Appeals Office at the address below or by e-mail to swappeals@welfare.ie within 21 days of the date you were notified of the decision.

Social Welfare Appeals Office
D’Olier House
D’Olier Street
Dublin 2
LoCall: 1890 74 74 34


6. I have forms/documents to complete for other purposes and one of the questions asks for a claim number for Illness Benefit.  What is my Illness Benefit claim number?

Your PPSN number is the only number you need to quote in connection with your claim to Illness Benefit.  There is no separate claim number.


7. I have had a dental/optical procedure carried out and have been told that I should stay out of work for a period of time.  The dentist/optician does not have Social Welfare medical certificates.  What should I do?

Social Welfare medical certificates are only available from doctors who are on the Department’s panel of medical practitioners.  If your doctor will not certify you based on the advice of the dentist/ optician you should:

  • Get a certificate from your dentist/optician outlining the treatment/procedure involved. The certificate should also state the date from which you are unfit for work and the date you will be fit to resume.
  • Obtain and complete form IB1 (application form for Illness Benefit and Injury Benefit), directly from Illness Benefit Branch, by telephoning: LoCall 1890 92 84 00 (from Republic
  • Send the completed form IB1 (application form for Illness Benefit and Injury Benefit) and certificate(s) to: Department of Employment Affairs and Social Protection, P.O. Box 1650, Dublin 1.

Note: Your PPS number must be quoted on all medical certificates and correspondence as well as your current postal address.

Last modified:17/07/2019